Most Effective Piles Treatments
Piles or hemorrhoids are varicose veins of the anus or rectum, which feel like little lumps or balls. They may be painful, but are not dangerous. They frequently appear during pregnancy and may go away afterwards. Certain bitter plant juices (witch hazel, cactus, etc.) dabbed on hemorrhoids help shrink them. So do hemorrhoid suppositories (p. 392). Sitting in a bath of warm water can help the hemorrhoid heal. Very large hemorrhoids may require an operation. Get medical advice. If a hemorrhoid begins to bleed, the bleeding can sometimes be controlled by pressing with a clean cloth directly on the hemorrhoid. If the bleeding still does not stop, seek medical advice. Or try to control the bleeding by removing the clot that is inside the swollen vein. Tweezers like these can be used after they have been sterilized by boiling.
Internal hemorrhoids can be seen as smoothly marginated and curved filling defects that project into the rectal vault, lying adjacent to the rectal tube tip (Fig. 14.1). In contradistinction, low rectal cancers will normally have shouldering, and arise some distance from the anus itself. Physical examination usually confirms the presence of internal hemorrhoids. If the remainder of the colorectum has been cleared of significant lesions, a limited proctoscopic or sigmoidoscopic examination can be performed, if digital examination is nondiagnostic.
Treatment of complications of disease is largely supportive. Patients with seizures do not need anticonvulsant therapy, since more than one seizure is uncommon.46 Where readily available, anticonvulsants are often given before the cause of the seizure becomes apparent. Patients with HUS may require both transfusions and peritoneal dialysis. Even with these interventions, mortality from S. dysenteriae-associated HUS remains higher than in HUS associated with other infections.74,75 Whether this is because the underlying infection is more severe or because facilities for managing these complications in areas where S. dysenteriae type 1 outbreaks occur are often poor, or both, is uncertain. Toxic megacolon can be associated with a mortality rate as high as 50 .47 Colectomy, which may be necessary in treating megacolon due to ulcerative colitis in developed countries, is rarely an option in developing countries because long-term care for a child with a colectomy usually is unavailable. If...
Infusion of capsaicin (0.13-0.65 mM) into the human jejunum induces pain whose abdominal localization and perceptional quality are similar to distension-induced pain 84 . Since it does not stimulate jejunal motility and does not alter jejunal mechanosensitivity, capsaicin is thought to evoke pain by stimulation of jejunal chemoreceptors, presumably TRPV1 84 . Similarly, administration of a capsaicin solution (0.16 mM) into the ileum of patients with an ileostoma evokes abdominal pain, as well as referred somatic pain 83 . The effects of capsaicin-containing red pepper preparations have also been tested in IBS patients, given that spicy meals are said to exacerbate IBS symptoms. Acute ingestion of an intermediate chilli dose containing 46 mmol of capsaicin as single treatment does not alter the discomfort and pain thresholds for rectosigmoid distension in IBS patients, but lowers the pain threshold in healthy controls 87 . In contrast, intake of a low chilli dose containing 0.33 mmol...
Hemorrhoids can be tiny or extremely large, mimicking tumoral pathology. They typically appear as linear, smoothly delineated mucosal irregularities proximal to the ano-rectal margin (Figs. 8.32 and 8.33). Fig. 8.32a,b. False positive diagnosis internal haemorrhoids a axial image shows irregular, linear structures at the anorectal region (arrows) b corresponding endoluminal 3D image shows linear, smoothly delineated structures at the anorectal junction. (arrows) Fig. 8.32a,b. False positive diagnosis internal haemorrhoids a axial image shows irregular, linear structures at the anorectal region (arrows) b corresponding endoluminal 3D image shows linear, smoothly delineated structures at the anorectal junction. (arrows) Fig. 8.33a,b. False positive diagnosis internal haemorrhoids. (cont'd) (note different patient from Fig. 32) a axial image shows a small polyp-like nodule in the anorectal region. (arrow). Arrowhead thin rectal tube b corresponding endoluminal 3D image shows a linear,...
Alcoholic hepatitis gives rise to fibrosis ( CIRRHOSIS) of the liver, which increases portal vein resistance. With the development of portal hypertension ( 10 mmHg), there are portal-systemic anastomoses formed such as the left gastric-azygous (esophageal varices), the superior-middle and inferior rectal veins (hemorrhoids), the paraumbilical-inferior gastric (navel caput medusae), and the retroperitoneal-renal vein system.
Hemorrhoids, lower Gl bleed Variations from Normal. Black, tarry stool is associated with upper gastrointestinal bleeding consistent with ulcers and varices. Bright red stool is indicative of lower gastrointestinal tract bleeding as seen in hemorrhoids, ulcerative colitis, and cancer.
The answer is c. (Rock, 8le, pp 1211-1213.) The most common cause of fecal incontinence is obstetric trauma with inadequate repair. The rectal sphincter can be completely lacerated, but as long as the patient retains a functional puborectalis sling, a high degree of continence will be maintained. Generally the patient is continent of formed stool but not of flatus. Other causes of fecal incontinence include senility, central nervous system (CNS) disease, rectal prolapse, diabetes, chronic diarrhea, and inflammatory bowel disease. While rectal prolapse, CNS disease, and senility are thus potential causes of this condition, they can be excluded by the
Constipation), bloody stool, and a sense of urgency to empty the bowel, as well as pain in the rectal area (called tenesmus) (fig. 1.2). Proctosigmoiditis affects the rectum and sigmoid colon the first fifteen to fifty centimeters or so of the left colon above the rectum. Symptoms are diarrhea, bloody stool, cramps, and tenesmus. Moderate pain (persistent and crampy) often occurs on the left side of the abdomen when the disease is active.
The patient's sexual practice may be a major indication of the potential site of infection. In homosexual males, the rectum is the only site of gonococcal infection in 40 of reported cases. Rectal infection occurs through direct inoculation by receptive anal intercourse and often results in symptomatic disease.25,26 Symptoms can be quite mild with only pruritus and painless rectal discharge. Conversely, patients can experience severe rectal pain and bloody, mucopurulent discharge. Diagnosis is best made by anoscopy and culture, since external inspection may reveal few signs of infection. Without treatment the patient can become a chronic, asymptomatic carrier. Pharyngeal infection occurs in up to 25 of homosexual men and 7 of heterosexual men who engage in oral-genital contact with an infected partner. Over 90 of pharyngeal infections are asymptomatic but can produce an exudative pharyngitis or tonsillitis. The pharynx is the only site of infection in 5 of patients with gonococcal...
As a superb surgical professional, Galen made his mark. He operated on tumors, hemorrhoids, varicose veins, hydroceles, abdominal walls, intestines, and nasal polyps, and performed cleft-lip reconstructions and other procedures.9-11 He utilized common surgical instruments of the time, such as scalpels, forceps, hooks, arrow extractors, retractors, and scissors.9-11 He was a formidable surgical tactician with incredible anatomical and physiological knowledge, which he extrapolated into sound surgical practice. He advanced surgery by acknowledging well-known principles, improving surgical techniques, and enhancing his vast experience with gladiators, which permitted him to achieve better outcomes than his contemporaries.2,3,7,9
Clostridium perfringens type C has been the cause of both sporadic and epidemic cases of necrotizing enteritis. Clinical entities such as Darmbrand ( bowel gangrene ) in postwar Germany during the 1940s and pigbel97 in the Papua New Guinea highlands have been attributed to this organism, which elicits alpha and beta toxins capable of causing the enteritis. Poor nutrition and episodic dietary indulgence have been associated with these entities, with investigators suggesting that a low level of digestive enzymes in people with low protein dietary intake may prevent normal inactivation of bacterial toxins.98 Clinically, previously healthy patients present with a necrotizing enteritis syndrome that may include anorexia, nausea, vomiting, abdominal pain, and hematochezia and may progress to sepsis. Complications are common and include peritonitis secondary to bowel perforation, ileus, and chronic scarring leading to malabsorption, obstruction, or fistulas.
Operations for abscess drainage, amputations, cataract operations, tonsillectomy, neck tumor excision, lithotomy, obstetrical procedures, bowel obstructions, hemorrhoids, and anal fistulas were described in the Susruta-samhita long before they were ever adopted in Western medicine. A special chapter in the book is dedicated entirely to the pathology and treatment of fractures.
Cirrhosis is an end-stage liver disease due to many etiologies characterized by disruption of the liver architecture by bands of fibrosis that divide the liver into nodules of regenerating liver parenchyma. Complications of cirrhosis include portal hypertension, ascites, hypersplenism, esophageal varices, hemorrhoids, caput medusa, hepatic encephalopathy, spider angiomata, palmar erythema, gynecomastia, hypoalbuminemia, decreased clotting factors, and hepatorenal syndrome.
Hemorrhoids (or piles) are ulcerations of the hemorrhoidal vein (a vein which lies in close proximity to the external mucosa of the anus). Pain, itching, and general discomfort are the usual symptoms associated with hemorrhoids. However, complications such as infection or obstruction may arise. It is surgically possible to remove hemorrhoids.
When blood is present in feces in gross amounts, the color of the stool specimen may be red, gray, or black. Some common causes of large amounts of blood in fecal specimens are nosebleeds, esophageal varices, ulcers, carcinoma of the gastrointestinal tract, and hemorrhoids. When blood is present in trace (occult) amounts, chemical tests are required for detection. Meat in an individual's diet may cause reactions in some of the chemical tests. Thus, the patient should be placed on a meat-free diet for two or three days before the test for reliable results.
Proctoscopy is an endoscopic examination of the anus and rectum with an instrument called a proctoscope, and sigmoidoscopy is an endoscopic examination of the sigmoid colon using a sigmoidoscope. When the anus, rectum, and sigmoid colon are examined at the same time, the procedure is known as a proctosigmoidoscopy and the instrument is called a proctosig-moidoscope. The endoscopes, which are inserted through the anal sphincter, can be rigid or flexible. The flexible fiberoptic instruments are the most commonly used endoscopes. Variations from Normal. Proctoscopic examinations are used to diagnose anal hemorrhoids, rectal prolapse, abscesses, fissures, polyps, and malignancies. They can also be used to identify and evaluate inflammatory bowel diseases such as ulcerative and granulomatous colitis. Regional enteritis, intestinal ischemia, and irritable bowel syndrome can be diagnosed and assessed via proctoscopy.
Laxatives One can use milk of magnesia or other magnesium salts in small doses, as laxatives, in some cases of constipation. People with hemorrhoids (piles, p. 175) who have constipation can take mineral oil but this only makes their stools slippery, not soft. The dose for mineral oil is 3 to 6 teaspoons at bedtime (never with a meal because the oil will rob the body of important vitamins in the food). This is not the best way.
Treatment Acute thrombosis will subside spontaneously in most cases with sitz baths, anti-inflainmatories, local steroids, and laxatives. If recurrent, surgical resection is warranted. If acutely painful or if conservative treatment fails, excision with local anesthesia may be done. Discussion External hemorrhoids are dilatations of the anal veins from the inferior hemorrhoidal plexus, which drains into the internal pudendal veins. Internal hemorrhoids lie above the mucocutaneous junction (pectinate line) and belong to the superior hemorrhoidal plexus, which drains into the portal vein through the inferior mesenteric vein. Internal hemorrhoids are painless (visceral innervation) and are covered by mucosa. External hemorrhoids are painful (somatic innervation) and are covered by skin.
Examples of prescriptions include one where animal parts were mixed in wine to procure an abortion rub a mixture of lizard's liver, skin of the cicada locust and wine on to the navel. Or the flesh of a pit viper was prepared by placing the snake in a gallon of wine then burying the sealed jar under a horse's stall for one year. The resultant liquid was a cure for apoplexy, fistula, stomach pain, heart pain, colic, haemorrhoids, worms, flatulence and bleeding from the bowel. Alcoholism could be cured by donkey's placenta mixed in wine, the liver of a black cat in wine for malaria, and to cure a bad cold an owl was smothered to death, plucked and boiled, its bones charred and taken with wine (Read 1931-7).
Once the patient is ready and lying on the CT scanner table, a suitably qualified practitioner may choose to perform a rectal examination. This may be helpful for several reasons detecting an occlusive tumour will avoid a potentially difficult and unsafe rectal catheter insertion and anal sphincter tone can be assessed quickly, which may influence the choice of catheter or method of insufflation. Digital rectal examination may also aid subsequent interpretation which can be particularly challenging in the rectum due to the frequent presence of haemorrhoids and redundant rectal mucosa. Despite these advantages, rectal examination may not always be appropriate, particularly for an asymptomatic screening population. One compromise is to only perform a rectal examination in patients with symptoms of rectal cancer, such as rectal bleeding or in those suspected of having poor anal tone (see section below).
Sixty-eight-year-old male with large internal hemorrhoids at endoscopy. a) axial CT image, b) 3D endoluminal image at CT colonography. Note the smoothly marginated and curved filling defects (arrow) that project into the rectal vault, lying adjacent to the rectal tube tip (arrowhead) Fig. 14.1a,b. Sixty-eight-year-old male with large internal hemorrhoids at endoscopy. a) axial CT image, b) 3D endoluminal image at CT colonography. Note the smoothly marginated and curved filling defects (arrow) that project into the rectal vault, lying adjacent to the rectal tube tip (arrowhead)
A 27-year-oid woman comes to the emergency department because of severe abdominal and pelvic pain for the past 12 hours. She says she has two sexual partners that she has been with for years. She is not sure if they are involved with any other women. Her last menstrual period was 4 days ago, and it was normal. She denies any rectal pain or change in bowel habits. Physical examination shows cervical motion tenderness, bilateral lower abdominal tenderness, and right-upper quadrant tenderness. Which of the following is the most likely diagnosis 2. A 32-year-old woman comes to the physician with her husband because she just can't seem to get pregnant. They have been unsuccessfully trying to conceive for the past 14 months, having unprotected sexual intercourse during her fertile days. Her menstrual periods arrive at regular 28-day intervals, but they are accompanied by severe abdominal cramps. She says that often experiences rectal pain during defecation and pelvic pain during sexual...
Latency varies from several months to more than 10 years. The initial phase is characterized by fever, diarrhea, weight loss (wasting syndrome in 40-68 of cases), adenopathy, pruritus and other manifestations depending upon the level of cell-mediated immunosuppression. Many sexually transmitted diseases accompany AIDS gonorrhea, syphilis, hepatitis B, A, and non-A, non-B, pharyngitis, and chlamydial proctitis. In AIDS-related complex (ARC), neurologic or systemic illnesses appear, opportunist infections like oral candidiasis, multidermatomal herpes zoster, hairy cell leukoplasia, seborrheic dermatitis and retinal spots in cotton branches. Pre-existing dermatoses, like atopic dermatitis, psoriasis and Reiter's syndrome, deteriorate as the acquired immunodeficiency syndrome becomes increasingly severe. When AIDS is established, the following can appear Kaposi's sarcoma (7-50 ) (Fig.58.1), Hodgkin's disease and non-Hodgkin-lymphoma, Pneumocystis carinii pneumonia (74 ) that presents on...
Acute thrombosis will subside spontaneously in most cases with sitz baths, anti-inflammatones, local steroids, and laxatives. If recurrent, surgical resection is warranted. If acutely painful or if conservative treatment fails, excision with local anesthesia may be done. Discussion External hemorrhoids are dilatations of the anal veins from the inferior hemorrhoidal plexus, which drains into the internal pudendal veins. Internal hemorrhoids lie above the mucocutaneous junction (pectinate line) and belong to the superior hemorrhoidal plexus, which drains into the portal vein through the inferior mesenteric vein. Internal hemorrhoids are painless (visceral innervation) and are covered by mucosa. External hemorrhoids are painful (somatic innervation) and are covered by skin.
FINDINGS After historical and physical assessment appropriate for this procedure, the patient was placed on triple monitoring and put in the left lateral decubitus position. He was given IV sedation. A rectal exam revealed a generous prostate. The colonoscope was introduced and advanced through quite a loopy sigmoid to the cecum. Reaching the cecum was facilitated by placing him in the right lateral decubitus position when the scope was at the level of the midtransverse colon. Then advancing it was quite easy. Landmarks were unequivocally identified, including the ileocecal valve, the terminal ileum, which was transiently visualized, and the appendiceal orifice. On slow withdrawal and careful inspection of the mucosa, the above polyps were noted and removed with a minisnare and recovered for pathologic examination. A diminutive polyp at 40 cm was cauterized, and retroflex view of the anal ring showed grade 2 internal hemorrhoids.
A 15-month-old child is seen for cramping, colicky abdominal pain of 12 h duration. He has had two episodes of vomiting and a fever. Physical examination is remarkable for a lethargic child abdomen is tender to palpation. Leukocytosis is present. During examination, the patient passes a bloody stool with mucus. Differential Diagnosis. Gastroenteritis presents similarly to the initial stages of intussusception. Meckel diverticulum produces GI bleeding but it is usually painless. Henoch-Schonlein purpura produces bloody stools and may cause intussusception.
Low fiber intake and poor diet can cause constipation. Medications also can lead to constipation (Table 21.1). Constipation is associated with many metabolic and endocrine disorders, including hypocalcemia, renal failure, hy-pothyroidism, hyperparathyroidism, and diabetes.1 Neurological disorders can impede normal GI movement multiple sclerosis, strokes, and spinal cord injury can cause constipation. Malfunction or anatomical abnormalities, including colitis, cancer, diverticular disease, and rectal prolapse, can cause constipation.
A 3-year-old white girl presents with rectal prolapse. She is noted to be in the less than 5 percentile for weight and height. The parents also note that she has a foul-smelling bulky stool each day that floats. They also state that the child has developed a repetitive cough over the last few months. Presentation. The presentation of cystic fibrosis is variable. Meconium ileus may be the initial manifestation. Children may also present because they have a salty taste when their parents kiss them. Others have recurrent respiratory infections, initially with S. aureus and H. influenzae, and later with Pseudomonas and Aspergillus. Some children may have malabsorption secondary to pancreatic insufficiency with history of steatorrhea and fat-soluble vitamin deficiency (A, D, K, and E). Still others may present with nasal polyps, or rectal prolapse. On physical examination, the patient may have a protuberant abdomen and decreased muscle mass. The patient may show evidence of vitamin...
Because of the ubiquity of E. coli in fecal material, definitive diagnosis of enteric infections with enterovirulent E. coli often involves sophisticated techniques to detect the virulence traits themselves, many of which are beyond the scope of most clinical diagnostic laboratories. Of the enterovirulent E. coli, EHEC is most easily identified because of the dominant prevalence of serotype O157 H7. Because E. coli O157 H7, unlike most E. coli, does not ferment sorbitol, sor-bitol-MacConkey agar is used as a screening medium. Presumptive diagnosis of E. coli O157 H7 infection can be made when sorbitol-negative (clear) E. coli isolates are shown to agglutinate in the presence of E. coli O157 antiserum.153 However, non-O157 EHEC isolates, which can cause human disease, will be missed by this method. Newer immunologic techniques that detect SLT-I and SLT-II in stool are therefore in widespread use.154 Screening for EHEC by one of these methods is recommended for all bloody stool samples...
While people who suffer from ulcerative colitis often have a normal anal exam, those with Crohn disease can show any one of a number of abnormalities, many of which are very painful. Among these are hemorrhoids anal fissures (cracks in the lining of the anus, which are extraordinarily painful) thick, cauliflower-like mounds that are quite tender false openings called sinus tracts, which often give off a discharge and perianal
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